United States District Court, D. New Jersey
D. WIGENTON, U.S.D.J.
the Court is defendant Local 464A United Food and Commercial
Workers Union Welfare Service Benefit Fund's
(“Defendant”) Motion to Dismiss and plaintiff
Kristine Guariglia's (“Plaintiff”) Cross
Motion for Partial Summary Judgment. Jurisdiction is proper
pursuant to 28 U.S.C. § 1132(e)(1). Venue is proper
pursuant to 28 U.S.C. § 1132(e)(2). This opinion is
issued without oral argument pursuant to Federal Rule of
Civil Procedure 78. For the reasons set forth below,
Defendant's Motion to Dismiss is GRANTED
and Plaintiff's Cross Motion is DENIED.
BACKGROUND AND PROCEDURAL HISTORY
April 4, 2012, Plaintiff was a participant in a health plan
(the “Plan”) administered by Defendant, when
Plaintiff tripped and was injured due to a pothole in a
public roadway. (Compl. ¶¶ 4-5.) As a result,
Plaintiff incurred medical expenses and may continue to incur
expenses in the future due to the injuries she sustained.
(Id.) The Plan is governed by the Employee
Retirement Income and Security Act, 29 U.S.C. § 1001 et
seq., (“ERISA”). (Id. ¶ 1.)
November 13, 2012, Plaintiff filed a lawsuit in the Superior
Court of New Jersey against James R. Ientile, Inc., Esposito
Construction, the Borough of Matawan, Borough of Matawan
Sewerage Authority, XYZ Corp., and John Does 1-10 for
personal injuries arising from her accident (“Liability
Action”). (Id. ¶ 6.) Plaintiff also filed
a claim against the Plan for payment of medical expenses
incurred in connection with the injuries that she sustained.
(Id. ¶ 7.) The Plan advised Plaintiff that
before it would cover her medical costs, it required her to
execute an Agreement to Reimburse and for Equitable Lien (the
“Agreement”) “by which plaintiff would have
agreed to reimburse the Plan out of any recovery” that
she could realize as a result of the Liability Action.
(Id. ¶¶ 8-9.) Plaintiff declined to sign
the Agreement. (Id. ¶ 9.)
February 25, 2013, Plaintiff filed suit in this Court,
attempting to “compel the Plan to pay her medical
expenses notwithstanding her refusal to sign the
Agreement.” (Id. ¶ 10; see also
Guariglia v. Local 464A United Food & Commercial Workers
Union Welfare Serv. Benefit Fund, Civ. No. 13-1110, 2013
WL 6188510 (D.N.J. Nov. 25, 2013) (“Guariglia
I”). Shortly thereafter, Defendant moved to
dismiss and Plaintiff filed a cross motion for summary
judgment. Guariglia I, 2013 WL 6188510 at *2. This
Court granted Defendant's motion on November 25, 2013,
finding that the Plan “does not cover healthcare
expenses for which a third party is responsible to pay”
and that its terms permitted it to condition “payment
of medical expenses upon a Reimbursement Agreement.”
Id. at *5. This Court further denied Plaintiff's
cross motion, rejecting Plaintiff's argument “that
the Plan is required to pay Plaintiff's medical expenses
as a primary payor and that it had no valid equitable claim
against her recovery from” the Liability Action.
Id. at *7.
four years later, the Liability Action went to trial and the
jury verdict finding no cause of action was memorialized in
an Order for Judgment entered in the state court on May 22,
2017. (Compl. ¶ 12.) On January 2, 2018, Plaintiff filed
the instant suit in this Court, again seeking to force
Defendant to “pay medical expenses associated with her
[L]iability [A]ction.” (Id. ¶ 17.)
Defendant moved to dismiss Plaintiff's Complaint pursuant
to Federal Rule of Civil Procedure 12(b)(6). (Dkt. No. 4.)
Plaintiff opposed the motion and filed a cross motion for
partial summary judgment pursuant to Federal Rule of Civil
Procedure 56. (Dkt. No. 5.)
adequate complaint must be “a short and plain statement
of the claim showing that the pleader is entitled to
relief.” Fed.R.Civ.P. 8(a)(2). This Rule
“requires more than labels and conclusions, and a
formulaic recitation of the elements of a cause of action
will not do. Factual allegations must be enough to raise a
right to relief above the speculative level[.]”
Bell Atlantic Corp. v. Twombly, 550 U.S. 544, 555
(2007) (internal citations omitted); see also Phillips v.
Cty. of Allegheny, 515 F.3d 224, 231 (3d Cir. 2008)
(stating that Rule 8 “requires a ‘showing, '
rather than a blanket assertion, of an entitlement to
considering a Motion to Dismiss under Rule 12(b)(6), the
Court must “accept all factual allegations as true,
construe the complaint in the light most favorable to the
plaintiff, and determine whether, under any reasonable
reading of the complaint, the plaintiff may be entitled to
relief.” Phillips, 515 F.3d at 231 (external
citation omitted). However, “the tenet that a court
must accept as true all of the allegations contained in a
complaint is inapplicable to legal conclusions. Threadbare
recitals of the elements of a cause of action, supported by
mere conclusory statements, do not suffice.”
Ashcroft v. Iqbal, 556 U.S. 662, 678 (2009); see
also Fowler v. UPMC Shadyside, 578 F.3d 203 (3d Cir.
2009) (discussing the Iqbal standard). Determining
whether the allegations in a complaint are
“plausible” is “a context-specific task
that requires the reviewing court to draw on its judicial
experience and common sense.” Iqbal, 556 U.S.
at 679. If the “well-pleaded facts do not permit the
court to infer more than the mere possibility of misconduct,
” the complaint should be dismissed for failing to
“show that the pleader is entitled to relief”
as required by Rule 8(a)(2). Id.
for Summary Judgment
judgment is appropriate “if the movant shows that there
is no genuine dispute as to any material fact and the movant
is entitled to judgment as a matter of law.”
Fed.R.Civ.P. 56(a). The “mere existence of some alleged
factual dispute between the parties will not defeat an
otherwise properly supported motion for summary judgment; the
requirement is that there be no genuine issue of material
fact.” Anderson v. Liberty Lobby, Inc., 477
U.S. 242, 247-48 (1986). A fact is only
“material” for purposes of a summary judgment
motion if a dispute over that fact “might affect the
outcome of the suit under the governing law.”
Id. at 248. A dispute about a material fact is
“genuine” if “the evidence is such that a
reasonable jury could return a verdict for the nonmoving
party.” Id. The dispute is not genuine if it
merely involves “some metaphysical doubt as to the
material facts.” Matsushita Elec. Indus. Co. v.
Zenith Radio Corp., 475 U.S. 574, 586 (1986).
moving party must show that if the evidentiary material of
record were reduced to admissible evidence in court, it would
be insufficient to permit the nonmoving party to carry its
burden of proof. Celotex Corp. v. Catrett, 477 U.S.
317, 322-23 (1986). Once the moving party meets its initial
burden, the burden then shifts to the nonmovant who must set
forth specific facts showing a genuine issue for trial and
may not rest upon the mere allegations, speculations,
unsupported assertions or denials of its pleadings.
Shields v. Zuccarini, 254 F.3d 476, 481 (3d Cir.
2001). “In considering a motion for summary judgment, a
district court may not make credibility determinations or
engage in any weighing of the evidence; instead, the
non-moving party's ...